The Medical Records Release Form is a crucial document used in Nigerian healthcare settings when there is a need to transfer or share patient medical information between authorized parties. This form is essential for compliance with the National Health Act 2014 and the Nigeria Data Protection Regulation (NDPR) 2019, which govern the handling and transfer of sensitive medical information. It is typically required when patients need their records transferred to new healthcare providers, for insurance claims, legal proceedings, or continued medical care. The form includes detailed patient information, specific authorization parameters, and clear consent mechanisms. Healthcare providers must maintain these forms to demonstrate compliance with privacy regulations and ensure proper documentation of all medical record transfers. The document serves as both a legal protection mechanism and a standardized process for managing patient data requests in accordance with Nigerian healthcare regulations.
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1. Patient Information: Complete identification details of the patient including full name, date of birth, address, phone number, and medical record number
2. Healthcare Provider Information: Details of the healthcare provider/facility currently holding the medical records, including name, address, and contact information
3. Recipient Information: Details of the person or entity to whom the medical records are to be released, including name, address, and contact information
4. Information to be Released: Specific description of the medical information to be released, including date ranges and types of records
5. Purpose of Disclosure: Statement of the reason for requesting the medical records release
6. Authorization Statement: Clear statement of authorization and understanding of the release terms
7. Duration of Authorization: Specification of how long the authorization remains valid
8. Rights and Notices: Statement of patient rights including right to revoke authorization and privacy notices as per NDPR requirements
9. Signatures: Space for patient or authorized representative signature, date, and witness signature if required
1. Proxy Authorization: Additional section when someone other than the patient is authorizing the release, including legal authority documentation
2. Specific Restrictions: Section for specifying any restrictions on the information to be released or special handling instructions
3. Payment Information: Section detailing any fees associated with the records release, if applicable
4. Emergency Contact: Additional contact information section for urgent matters related to the records release
5. Translator Certification: Section for translator details and certification when the form needs to be translated for non-English speaking patients
1. Schedule A - Types of Medical Records: Detailed checklist of specific types of medical records that can be released (e.g., laboratory results, imaging reports, consultation notes)
2. Schedule B - Fee Schedule: If applicable, detailed breakdown of fees associated with different types of medical records release
3. Appendix 1 - Privacy Notice: Detailed privacy notice in compliance with NDPR 2019 requirements
4. Appendix 2 - Patient Rights: Comprehensive explanation of patient rights regarding medical records and their release
Relevant legal definitions
Medical Records
Protected Health Information
Healthcare Provider
Authorized Representative
Release Authorization
Confidential Information
Personal Data
Data Subject
Healthcare Facility
Medical Information
Disclosure
Legal Guardian
Patient Rights
Authorization Period
Sensitive Personal Information
Data Controller
Data Processor
Electronic Health Records
Treatment Information
Medical History
Consent
Revocation
Third Party Recipient
Health Care Operations
Digital Records
Protected Health Information
Healthcare Provider
Authorized Representative
Release Authorization
Confidential Information
Personal Data
Data Subject
Healthcare Facility
Medical Information
Disclosure
Legal Guardian
Patient Rights
Authorization Period
Sensitive Personal Information
Data Controller
Data Processor
Electronic Health Records
Treatment Information
Medical History
Consent
Revocation
Third Party Recipient
Health Care Operations
Digital Records
Clauses
Consent
Authorization
Privacy
Data Protection
Confidentiality
Information Access
Duration
Revocation Rights
Release Scope
Record Types
Disclosure Limitations
Fee Provisions
Liability
Representations and Warranties
Patient Rights
Third Party Disclosure
Data Security
Records Delivery
Governing Law
Witness Requirements
Authorization
Privacy
Data Protection
Confidentiality
Information Access
Duration
Revocation Rights
Release Scope
Record Types
Disclosure Limitations
Fee Provisions
Liability
Representations and Warranties
Patient Rights
Third Party Disclosure
Data Security
Records Delivery
Governing Law
Witness Requirements
Relevant Industries
Healthcare
Insurance
Legal Services
Healthcare Technology
Medical Research
Pharmaceutical
Public Health
Social Services
Education (Medical Institutions)
Relevant Teams
Medical Records
Compliance
Legal
Patient Services
Administration
Operations
Data Protection
Clinical Operations
Quality Assurance
Information Management
Relevant Roles
Medical Records Officer
Healthcare Administrator
Compliance Officer
Privacy Officer
Medical Director
Hospital Administrator
Clinical Director
Legal Counsel
Data Protection Officer
Healthcare Facility Manager
Patient Services Coordinator
Medical Secretary
Insurance Claims Processor
Healthcare Operations Manager
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